Glycopyrronium Bromide (Respirator Solution) interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system.

  What to do: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

  1 source

  1. Linnoila M "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol 6 (1973): 107-12

Conditions

Conditions in which Glycopyrronium Bromide (Respirator Solution) needs care, as documented in this source.

• Arrhythmias, Cardiac

  Major

  Patients with tachycardia should be supervised closely during treatment with anticholinergic agents. Tachycardia is produced by blocking normal vagal inhibition of the SA node. Paradoxically, bradycardia may occur due to central vagal stimulation which may occur prior to peripheral cholinergic blockade.

  3 sources

  1. Blumensohn R, Razoni G, Shalev A, Munitz H "Bradycardia due to trihexyphenidyl hydrochloride." Drug Intell Clin Pharm 20 (1986): 786-7
  2. Voinov H, Elefante V, Mujica R "Sinus bradycardia related to the use of benztropine mesylate." Am J Psychiatry 149 (1992): 711
  3. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):

• Diabetic Neuropathies

  Major

  Agents with anticholinergic activity can exacerbate many of the manifestations of autonomic neuropathy, including tachycardia, anhidrosis, bladder atony, obstipation, dry mouth and eyes, cycloplegia and blurring of vision, and sexual impotence in males. Therapy with antimuscarinic agents and higher dosages of antispasmodic agents (e.g., dicyclomine or oxybutynin) should be administered cautiously in patients with autonomic neuropathy.

  1 source

  1. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):

• Dysentery

  Major

  The use of drugs with antiperistaltic activity (primarily antidiarrheal and antimuscarinic agents, but also antispasmodic agents such as dicyclomine or oxybutynin at high dosages) is contraindicated in patients with diarrhea due to pseudomembranous enterocolitis or enterotoxin-producing bacteria. These drugs may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella and Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. In general, because antiperistaltic agents decrease gastrointestinal motility, they may delay the excretion of infective gastroenteric organisms or toxins and should be used cautiously in patients with any infectious diarrhea, particularly if accompanied by high fever or pus or blood in the stool. Some cough and cold and other combination products may occasionally include antimuscarinic agents for their drying effects and may, therefore, require careful selection when necessary.

  6 sources

  1. Brown JW "Toxic megacolon associated with loperamide therapy." JAMA 241 (1979): 501-2
  2. Walley T, Milson D "Loperamide related toxic megacolon in Clostridium difficile colitis." Postgrad Med J 66 (1990): 582
  3. "Product Information. Imodium (loperamide)." Janssen Pharmaceuticals (2001):
  4. Marshall WF Jr, Rosenthal P, Merritt RJ "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr 9 (1989): 532-4
  5. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104
  6. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):

• Glaucoma

  Major

  Anticholinergic agents are contraindicated in patients with primary glaucoma, a tendency toward glaucoma (narrow anterior chamber angle), or adhesions (synechiae) between the iris and lens, as well as for the elderly and others in whom undiagnosed glaucoma or excessive pressure in the eye may be present. Because anticholinergics cause mydriasis, they may exacerbate these conditions.

  23 sources

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  4. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  5. "Product Information. Periactin (cyproheptadine)." Merck & Co., Inc (2002):
  6. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  7. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  8. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):

  Show all 23 sourcesShow fewer sources

  9. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  10. O'Connor PS, Mumma JV "Atropine toxicity." Am J Ophthalmol 99 (1985): 613-4
  11. Clearkin LG "Angle closure glaucoma precipitated by atropine." Arch Intern Med 152 (1992): 880
  12. Berdy GJ, Berdy SS, Odin LS, Hirst LW "Angle closure glaucoma precipitated by aerosolized atropine." Arch Intern Med 151 (1991): 1658-60
  13. Pecora JL "Malignant glaucoma worsened by miotics in a postoperative angle- closure glaucoma patient." Ann Ophthalmol 11 (1979): 1412-4
  14. Holland MG "Autonomic drugs in ophthalmology: some problems and promises. Section II: Anticholinergic drugs." Ann Ophthalmol 6 (1974): 661-4
  15. Kanto J "New aspects in the use of atropine." Int J Clin Pharmacol Ther Toxicol 21 (1983): 92-4
  16. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  17. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  18. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34
  19. "Product Information. Cogentin (benztropine)." Merck & Co., Inc (2001):
  20. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  21. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  22. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  23. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):

• Intestinal Obstruction

  Major

  Anticholinergics are contraindicated in patients with obstructive diseases such as achalasia, esophageal stricture or stenosis, pyloroduodenal stenosis, stenosing peptic ulcer, pyloric obstruction, and paralytic ileus. Anticholinergics may further suppress intestinal motility with resultant precipitation or aggravation of toxic megacolon.

  16 sources

  1. Bantz EW, Dolen WK, Chadwick EW, Nelson HS "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  2. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  3. Blamoutier J "Comparative trial of two antihistamines, mequitazine and brompheniramine." Curr Med Res Opin 5 (1978): 366-70
  4. "Azatadine (optimine)--a new antihistamine." Med Lett Drugs Ther 19 (1977): 77-9
  5. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  6. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  7. "Product Information. Periactin (cyproheptadine)." Merck & Co., Inc (2002):
  8. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  11. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  12. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  13. Mevorach D "Adverse effects of atropine sulfate autoinjection." Ann Pharmacother 26 (1992): 564
  14. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  15. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  16. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):

• Myasthenia Gravis

  Major

  The use of glycopyrrolate is contraindicated in patients with myasthenia gravis.

  1 source

  1. "Product Information. Cuvposa (glycopyrrolate)." Shionogi USA Inc (2010):

• Tardive Dyskinesia

  Major

  Anticholinergic agents and agents with secondary anticholinergic activity may aggravate tardive dyskinesia or induce previously suppressed symptoms. Therapy with these agents should be avoided, if possible, or administered cautiously in patients with preexisting tardive dyskinesia, particularly in the elderly. If tardive dyskinesia symptoms develop or worsen during treatment with an anticholinergic agent, prompt withdrawal of therapy will provide better chances of improving the condition.

  7 sources

  1. Brait KA, Zagerman AJ "Dyskinesias after antihistamine use ." N Engl J Med 296 (1977): 111
  2. Jones B, Lal S "Tardive dyskinesia uncovered after ingestion of Sominex, an over-the- counter drug." Can J Psychiatry 30 (1985): 370-1
  3. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  4. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  5. Burnett GB, Prange AJ Jr, Wilson IC, Jolliff LA, Creese IC, Synder SH "Adverse effects of anticholinergic antiparkinsonian drugs in tardive dyskinesia. An investigation of mechanism." Neuropsychobiology 6 (1980): 109-20
  6. Kiloh LG, Smith JS, Williams SE "Antiparkinson drugs as causal agents in tardive dykinesia." Med J Aust 2 (1973): 591-3
  7. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):

• Urinary Bladder Neck Obstruction

  Major

  In general, the use of anticholinergic agents is contraindicated in patients with urinary retention and bladder neck obstruction caused by prostatic hypertrophy. Dysuria may occur and may require catheterization. Also, anticholinergic drugs may aggravate partial obstructive uropathy. Caution is advised even when using agents with mild to moderate anticholinergic activity, particularly in elderly patients.

  20 sources

  1. Bantz EW, Dolen WK, Chadwick EW, Nelson HS "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  2. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  3. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  5. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  6. "Product Information. Periactin (cyproheptadine)." Merck & Co., Inc (2002):
  7. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  8. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):

  Show all 20 sourcesShow fewer sources

  9. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  10. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  11. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  12. Shutt LE, Bowes JB "Atropine and hyoscine." Anaesthesia 34 (1979): 476-90
  13. O'Kelly SW, Spargo PM "Postoperative urinary retention in men." BMJ 302 (1991): 1403-4
  14. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  15. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  16. "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals (2001):
  17. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  18. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  19. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  20. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):

• Psychotic Disorders

  Moderate

  Toxic psychosis manifested as confusion, disorientation, agitation, excitation, memory impairment, delusions and hallucinations may develop at toxic and therapeutic dosages of antimuscarinic agents. Therapy with these agents should be administered cautiously in patients with mental disorders receiving antimuscarinic agents for control of drug-induced extrapyramidal effects, especially at the beginning of therapy or during dosage adjustment. Psychiatric deterioration and psychotic flare-ups have also been reported following withdrawal of therapy. Symptoms include delusions, hallucinations, aggression or violent behavior, and suicidal tendencies. In high dosages, antimuscarinic agents may sometimes produce euphorigenic effects. For this reason, it can be a drug of abuse.

  22 sources

  1. Jellinek T, Gardos G, Cole JO "Adverse effects of antiparkinson drug withdrawal." Am J Psychiatry 138 (1981): 1567-71
  2. Goggin DA, Solomon GF "Trihexyphenidyl abuse for euphorigenic effect." Am J Psychiatry 136 (1979): 459-60
  3. Macvicar K "Abuse of antiparkinsonian drugs by psychiatric patients." Am J Psychiatry 134 (1977): 809-11
  4. Craig DH, Rosen P "Abuse of antiparkinsonian drugs." Ann Emerg Med 10 (1981): 98-100
  5. Pullen GP, Best NR, Maguire J "Anticholinergic drug abuse: a common problem?" Br Med J (Clin Res Ed) 289 (1984): 612-3
  6. Rubinstein JS "Abuse of antiparkinsonism drugs. Feigning of extrapyramidal symptoms to obtain trihexyphenidyl." JAMA 239 (1978): 2365-6
  7. McInnis M, Petursson H "Trihexyphenidyl dependence." Acta Psychiatr Scand 69 (1984): 538-42
  8. Mohan D, Mohandas E, Dube S "Trihexyphenidyl abuse." Br J Addict 76 (1981): 195-7

  Show all 22 sourcesShow fewer sources

  9. Kaminer Y, Munitz H, Wijsenbeek H "Trihexyphenidyl (Artane) abuse: euphoriant and anxiolytic." Br J Psychiatry 140 (1982): 473-4
  10. Warnes H "Toxic psychosis due to antiparkinsonian drugs." Can Psychiatr Assoc J 12 (1967): 323-6
  11. Hidalgo HA, Mowers RM "Anticholinergic drug abuse." DICP 24 (1990): 40-1
  12. Wilcox JA "Psychoactive properties of benztropine and trihexyphenidyl." J Psychoactive Drugs 15 (1983): 319-21
  13. Laski E, Taleporos E "Anticholinergic psychosis in a bilingual: a case study." Am J Psychiatry 134 (1977): 1038-40
  14. Brower KJ "Smoking of prescription anticholinergic drugs." Am J Psychiatry 144 (1987): 383
  15. Baker LA, Cheng LY, Amara IB "The withdrawal of benztropine mesylate in chronic schizophrenic patients." Br J Psychiatry 143 (1983): 584-90
  16. Moreau A, Jones BD, Banno V "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry 31 (1986): 339-41
  17. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  18. Ananth JV, Jain RC "Benztropine psychosis." Can Psychiatr Assoc J 18 (1973): 409-14
  19. Woody GE, O'Brien CP "Anticholinergic toxic psychosis in drug abusers treated with benztropine." Compr Psychiatry 15 (1974): 439-42
  20. "Product Information. Cogentin (benztropine)." Merck & Co., Inc (2001):
  21. Kulik AV, Wilbur R "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 75-82
  22. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):

• Fever

  Minor

  Atropine-like agents may increase the risk of hyperthermia in patients with fever by producing anhidrosis. Therapy with atropine-like agents should be administered cautiously in febrile patients.

  6 sources

  1. Stadnyk AN, Glezos JD "Drug-induced heat stroke." Can Med Assoc J 128 (1983): 957-9
  2. Sarnquist F, Larson CP Jr "Drug-induced heat stroke." Anesthesiology 39 (1973): 348-50
  3. Lee BS "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry 47 (1986): 571
  4. Forester D "Fatal drug-induced heat stroke." JACEP 7 (1978): 243-4
  5. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  6. "Product Information. Cogentin (benztropine)." Merck & Co., Inc (2001):

• Hypertension

  Minor

  Cardiovascular effects of anticholinergics may exacerbate hypertension. Therapy with anticholinergic agents should be administered cautiously in patients with hypertension.

  7 sources

  1. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  2. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  3. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  4. Valentin N, Staffeldt H, Kyst A "Effect of i.v. atropine on cardiac rhythm, heart rate, blood pressure and airway secretion during isoflurane anaesthesia." Acta Anaesthesiol Scand 28 (1984): 621-4
  5. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  6. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  7. "Product Information. Atropisol (atropine ophthalmic)." Ciba Vision Ophthalmics (2002):

Therapeutic duplication

Drug classes that overlap with Glycopyrronium Bromide (Respirator Solution), so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Olodaterol/tiotropium

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Chlorpheniramine/methscopolamine/phenylephrine

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Urolet mb

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Phosphasal

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Sympak ii

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Motofen

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Librax

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Trelegy ellipta

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Butabarbital/hyoscyamine/phenazopyridine

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): B & o supprettes

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Hyoscyamine/phenyltoloxamine

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Duaklir pressair

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Duodote

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Tussigon

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Albuterol/ipratropium

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Vi-atro

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Anoro ellipta

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Prosed ds

• anticholinergics/antispasmodics

  The recommended maximum number of medicines in the 'anticholinergics/antispasmodics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'anticholinergics/antispasmodics' category.

  Example product in the source data (US market): Phenohytro